Bi-PAP users, tell me your story.

[davelikesbeer]

Today, I went in for a followup visit. It has been more then four months since I started CPAP and wanted to let the doctors know what I've been up to. My most recent concerns are having 3-5 awakenings per night along with mild to sleepiness during the day.

The doctors told me a couple of things. The first was that my acid reflux was mostly the result of my OSA, since being on APAP, I haven't had an issue with it. This was a completely unexpected benefit from my xPAP.

But the other thing they told me was that I will most likely have to go on BiPAP. They claimed that while I'm getting enough O2, I may not be expelling enough CO2 and this could be causing my daytime sleepiness.

For those on BiPAP, was the reason CPAP or APAP wasn't used? Did you even try something else?

[fiberfan]

I started on cpap last spring and did really well with the S9 AutoSet's EPR set to 3 working as a 'poor man's bi-level'. My asthma got lots worse last winter and I found breathing out against the pressure was as tiring as the consistent RERAs shown in my sleep study. In late April I switched to a bi-level and have been using the S9 VPAP Auto for 2 1/2 months. I have multiple sleep issues so I am still tired but the bi-level makes a noticeable difference in how tired I am.

[robysue]

The tale of why the sleep doc's PA suggested that I switch to bi-level can be found in this post from last November.

All I can say is that right from the start breathing with the BiPAP felt much more "normal" to me than breathing with the S9 AutoSet with EPR set at 2 or 3 ever did. And I'm glad I switched, even though I still had to deal with continuing nasty insomnia problems (hinted at in that old post) after the switch and even though the switch did not fully resolve the aerophagia problems until I was switched from fixed pressure at 8/6 to a tight auto range where my min EPAP = 4 and my max IPAP = 8.

[GumbyCT]

I didn't feel any better on cpap at 17cm. I had a brick and many leaks I am sure.

Got an auto and felt a little better then went for another PSG. Doc wanted to raise it to 18cm.

I told the RT don't even bother coming over as I had borrowed my dads bipap, printed out the results for a diff sleep doc who agreed the bipap was what I needed.

I couldn't exhale at 17 - what on earth makes a doc think 18 would be just what the doctor ordered?

A bipap is the Ultimate in exhale relief. That's my story and I'm stickin to it.

Life is Good.

[davelikesbeer]

The tale of why the sleep doc's PA suggested that I switch to bi-level can be found in this post from last November.

All I can say is that right from the start breathing with the BiPAP felt much more "normal" to me than breathing with the S9 AutoSet with EPR set at 2 or 3 ever did. And I'm glad I switched, even though I still had to deal with continuing nasty insomnia problems (hinted at in that old post) after the switch and even though the switch did not fully resolve the aerophagia problems until I was switched from fixed pressure at 8/6 to a tight auto range where my min EPAP = 4 and my max IPAP = 8.

That thread was an interesting read. I'm glad you had better results on BiPAP. Also JohnBFisher's comments regarding spontaneous arousals was interesting too me.

For now, I'm going to try a slightly different mask for two weeks. If I'm not sleeping better, I will let my doctor know and she will set me up with a bi-pap machine.

[graciegram]

About arousals: I am a 61-year old female and was told that some of the arousals can relate to changes in hormone levels. To combat this I was put on a very old antidepressant that my sleep doc frequently prescribes - doxepin. It seems to help me to stay asleep, anyway. Pat in OlyWA

[AlanMacNeill]

My doctor went right from initial consult to sleep study with split titration to BiPap inside of 2 weeks, passing right over the CPAP phase (also passing right over the 'let's watch for a night and see what happens' phase).

Of course, my expressed symptomology was classically horrible (massive snoring, frequent stoppages of breathing reported by the spouse, night terrors, sleepwalking, sleepyness during the day, and bad credit) (okay...I made the last one up, but wow, the laundry list was huge), and the sleep study found that I had a API of 35+ without anything, and I didn't respond a bit during the CPAP phase of the night, whereas I did fairly well with the BiPap.

I did have an issue with the first BiPap machine that I was issued. The prescription was 14/9, which is high but not obscene. The first machine I had, a Phillips S1, had two modes, High and Low, and the transitions between them were very sharp and not in sync with my breathing pattern at all. Althoguh my revised AHI was good (sub 1), I wasn't able to sleep with it at all.

The DME switched me about 2 weeks ago to a ResMed BiPap (it's actually an Auto, and has Auto capability, but I'm not *using* it yet). It doesn't do a hard "14,9,14,9,14...", it climbs from 9-14 gradually (over about a second) on the inhale, and retreats from 14-9 on the exhale, equally gradually. For me, that has made it so I barely even notice that I'm breathing forced air. If it wasn't for the mask, I'd be oblivious, and my numbers are pretty darned good on it, so far.

[davelikesbeer]

...
I did have an issue with the first BiPap machine that I was issued. The prescription was 14/9, which is high but not obscene. The first machine I had, a Phillips S1, had two modes, High and Low, and the transitions between them were very sharp and not in sync with my breathing pattern at all. Althoguh my revised AHI was good (sub 1), I wasn't able to sleep with it at all.

The DME switched me about 2 weeks ago to a ResMed BiPap (it's actually an Auto, and has Auto capability, but I'm not *using* it yet). It doesn't do a hard "14,9,14,9,14...", it climbs from 9-14 gradually (over about a second) on the inhale, and retreats from 14-9 on the exhale, equally gradually. For me, that has made it so I barely even notice that I'm breathing forced air. If it wasn't for the mask, I'd be oblivious, and my numbers are pretty darned good on it, so far.

Doesn't the PRS1 Bi-PAP Auto have "Bi-Flex" that provides exhale relief? So it shouldn't be a harsh 14,9,14,9... transition. Although, not sure how long the transition takes, I'd bet it was less than a second.

[MsBea]

I was put on bipap from the start because I "failed" cpap during my sleep study/titration. From the things I read, I'm glad I have bipap.

[cflame1]

...
I did have an issue with the first BiPap machine that I was issued. The prescription was 14/9, which is high but not obscene. The first machine I had, a Phillips S1, had two modes, High and Low, and the transitions between them were very sharp and not in sync with my breathing pattern at all. Althoguh my revised AHI was good (sub 1), I wasn't able to sleep with it at all.

The DME switched me about 2 weeks ago to a ResMed BiPap (it's actually an Auto, and has Auto capability, but I'm not *using* it yet). It doesn't do a hard "14,9,14,9,14...", it climbs from 9-14 gradually (over about a second) on the inhale, and retreats from 14-9 on the exhale, equally gradually. For me, that has made it so I barely even notice that I'm breathing forced air. If it wasn't for the mask, I'd be oblivious, and my numbers are pretty darned good on it, so far.

Doesn't the PRS1 Bi-PAP Auto have "Bi-Flex" that provides exhale relief? So it shouldn't be a harsh 14,9,14,9... transition. Although, not sure how long the transition takes, I'd bet it was less than a second.

I'm guessing that Alan was either on a Bipap Pro... or it was set to a straight Bipap mode.

[jilliansue]

I was put on BiPap during my titration sleep study. The tech first put me on a straight CPAP and then came in the room and said that I was "not even trying" and by that she meant not trying to breathe, I was having central apneas and I improved when she switched me to BiPAP. I do like the exhalation relief that is automatically the case in a BiPAP, but it is the only machine I have ever owned.

What I don't like is that my machine, while data capable, does not split out centrals from "plain ole" apneas. The S9 does, I understand. But for now, I am stuck with the S8 and it does seem to be working for me.

Jill

[davelikesbeer]

I have to be honest, I do feel a bit guilty about the possibility that my insurance company will have to buy me a new machine after using my APAP for only four months. I'm the type of person who doesn't like to waste anything, especially an expensive machine.

Here is the thing. If I knew for a fact that getting a bi-pap would be better, then I would not hesitate. However, my AHI is really great. So I'm really curious if the doctor is simply trying something different to see if I sleep better or feel better during the day. I don't know if I can even tolerate a Bi-PAP, although from your responses it seems it is even more tolerable than CPAP and I do just fine with my APAP set at 16-19.

I asked my DME what my options were for trial, and they said rent for $200/month.

Our healthcare system is really screwed up. My options are either rent for $200/m, buy for who knows how much, or go in for a bi-pap titration just to see if I can tolerate a bi-pap! I wish I had a friend nearby with a spare bi-pap.

The good news I suppose is that if I end up with a new BiPAP, I can sell one of my APAPs and keep the other as a backup.

Dave.

[LSAT]

If you are insured, the insurance company will probably pay about $90 month regardless of what the DME charges.

[GumbyCT]

I have to be honest, I do feel a bit guilty about the possibility that my insurance company will have to buy me a new machine after using my APAP for only four months. I'm the type of person who doesn't like to waste anything, especially an expensive machine.

Here is the thing. If I knew for a fact that getting a bi-pap would be better, then I would not hesitate.

It's not up to you. When you use insurance they often have requirements that you MUST have tried and failed cpap before they will cover a bipap. Part of that if they have a contract with you DME could be the DME is required to replace your machine should the prescription change ie. cpap > auto or bipap.

Of course if you feel that guilty pay for a bipap from cpap.com OOP

btw - I would go for the bipap titration. It will save you a lot of trouble.

[robysue]

Here is the thing. If I knew for a fact that getting a bi-pap would be better, then I would not hesitate. However, my AHI is really great. So I'm really curious if the doctor is simply trying something different to see if I sleep better or feel better during the day. I don't know if I can even tolerate a Bi-PAP, although from your responses it seems it is even more tolerable than CPAP and I do just fine with my APAP set at 16-19.

Don't undervalue the notions of night time comfort and sleeping better as they pertain to feeling better during the day.

For the most part, my AHI's were fantastic during the three months I was on CPAP/APAP. Many, many nights with AHI < 1.0 with many of those nights with AHI < 0.5. In the roughly 90 days I used the S9, I had a only handful of days with AHI > 3.5. My average AHI for the whole period was something on the order of 1.1 or 1.2. But the fact remained that I felt absolutely miserable during the daytime and would wake intensely up after strapping the hose on my nose. Why? Because the subjective quality of that apnea-free sleep was pretty piss-poor: Full of arousals and a seeming inability to really fall into a deep stage of sleep. I felt as though I was NOT dreaming very well on the S9 even when I had "clocked" 7 or 8 hours of time in bed spent "mostly" asleep---as in when I genuinely felt like I had gotten more than six hours of sleep. And I never really woke up feeling anywhere close to rested or anywhere close to refreshed in the three solid months that I used the S9 Autoset.

So while aerophagia was the primary complaint that led to my being switched, my overall discomfort and growing intolerance of the machine were significant factors for justifying the switch. And the switch of machines was critical, I believe, in my being able to keep fighting the good fight throughout a difficult spring filled with insomnia, allergies, and side effects to a series of migraine meds. And even with the rampant insomnia of last winter, the magic phrase I feel almost refreshed and definitely rested started to appear at least once or twice a week in my sleep logs within the first six weeks of starting BiPAP.

To be honest: My AHIs on my BiPAP with my current pressure levels are not as good as what I was getting with the S9. Since the beginning of May, my overall AHI has been up around 1.7. On a nightly basis, they bounce around from 0.5 to 3.0, but mainly stay in the 1.5 to 2.5 range. But guess what? I feel better now---as in substantially better---in spite of the higher AHI. And why? I attribute it to the fact that even when the insomnia was at its worst with the BiPAP, when I sleep, I actually sleep---as in I sleep deeply and soundly for the most part even with the wakes. I simply don't have the same restlessness and inability to get into a deep, sound sleep that seemed to define my personal reaction to the S9.